Treatment.- Keep the parts clean and dry. If the excrescences are troublesome, excise them with the knife and afterwards apply a mercuric bichloride lotion, strength one to two grains to the ounce of water. The principal internal remedy is Thuja.
Therapeutic Hints.- For the mucous tubercles the main remedies are: Cinnba., Nitr ac., Thuja.
Fig-warts, when complicated with gonorrhoea, require Thuja, Cinnba., Nitr. ac., Sulphur, Lycopodium.
When complicated with chancre, Cinnab., Nitr. ac., Phosphorus ac., Staphysagria, Thuja.
When flat, Magnes, Nitr. ac.
When exuberant, like cauliflower or mulberries, Thuja, Staphysagria
When fan-shaped, Cinnab.
When growing on pedicles, Lycopod., Nitr. ac.
When conical, Mercurius Solub.
When dry, Thuja, Staphysagria, Mercurius Solub., Nitr., ac., Lycopod.
When moist, suppurating, Nitr. ac., Thuja, Sulphur, Euphras.
When soft, spongy, Sulphur.
When intolerably burning and itching, Sabina.
Cinnabar.- Fan-shaped fig-warts accompanied by letter. In scrofulous infants and children.
Euphrasia.- Fig-warts at the anus.
Mercur. cor.- Dry fig-warts, or else fig-warts accompanied by acrid discharges. Soft, flat condylomata.
Mercurius nit.- Filiform fig-warts.
Mercurius praecip. ruber.- Fissured condylomata.
Mercur. sol.- Conical fig-warts; small, itching pimples which ulcerate and become incrusted; mild types.
Nitr-ac.- Pediculated and pen-shaped, moist condylomata; fig-warts on the glans.
Sabina.- Condylomata attended with itching and burning.
Sarsaparilla.- Flat fig-warts.
Staphisagria.- Clock’s-comb-shaped fig-warts.
Sulphur.- Soft, spongy fig-warts.
Thuja,- Cauliflower excrescences. Condylomata on the penis, vulva and about the anus; broad, flat condylomata; after iritis, tubercles or warty excrescences on the iris.
Leprosy.
Leprosy is a disease that has been known form the earliest ages, and has prevailed among all races and in all climes.
At present it is most wide-spread in countries lying both to the north and to the south of the temperate zone and among the less enlightened people of the earth. To a limited extent, however, it is met with in Europe and the United States.
The disease manifests itself in three chief forms of phases of development, known as the macular, tubercular, anaesthetic. The first is characterized by the development of brownish discolorations of varying size and number. These, after an existence of months or years, may lose their heightened color and become pigmentless, and the cutaneous nerves in the affected parts lose their sensibility.
The tubercular form is characterized by the development of tubercles upon various parts of the body. These exhibit a slightly heightened color, becoming later somewhat copper- colored, and affect a preference for the face, especially just above the eyebrows and upon the nose and ears, but may, and usually do, appear upon the extremities.
In the anaesthetic form, bullae, usually solitary, develop upon various parts of the integument. They persist for a short time only and leave behind them discolorations, which in time may become whitened and anaesthetic. In this from of the disease there is grave implication of the principal nerve-trunks of the extremities. This is notably the case with the ulnar nerve, which in cases moderately advanced may be readily perceived as a thickened cord just above the head of the bone whose name it bears. In this form, especially, pain in the extremities is a more or less prominent feature. Connected with the development of the disease, anaesthesia of the integument, chiefly of the extremities, becomes a prominent feature. The gradual destruction of the ulnar nerve leads to impairment of its functions and atrophy of the more distant parts to which it is distributed. This atrophic action is most distinctly manifested in the fingers and toes. Fissures occur in the integument, and absorption of the phalanges takes place and leads to loss of these parts. The separation usually occurs at some point between the joints than at the joints themselves. A continuance of the morbid action may result in loss of all the phalanges, and even of some of the metacarpal and metatarsal bones.
Leprosy is essentially a chronic disease. Before the appearance of cutaneous or nervous lesions there usually exists a prodromal period of several years’ duration, without definite symptoms other than impairment of the general vigor. During this period it is hardly possible to make a diagnosis of the impending trouble. After the disease, however is fully developed, ten, fifteen, or twenty years may pass before the fatal termination.
After careful investigation Drs. Fox and Graham arrive at the following conclusions concerning leprosy:
1. Leprosy is a constitutional disease, and, in certain cases, appears to be hereditary.
2. It is undoubtedly contagious by inoculation.
3. There is no reason for believing that it is transmitted in any other way.
4. Under certain conditions a person may have leprosy and run no risk of transmitting the disease.
5. It is no so liable to be transmitted to others as is syphilis in its early stages. There is no relation between the two disease.
6. Leprosy is usually a fatal disease-its average duration being from ten to fifteen years.
7. In rare instances there is a tendency to recover after the disease has existed many years.
8. There is no valid reason for pronouncing the disease incurable.
9. Judicious treatment improves the condition of the patient and often causes a temporary disappearance of the symptoms.
10. There is a ground for the hope that an improved method of treatment will in time effect the cure of leprosy, or at least that it will arrest and control the disease.
Dr. Perry has arrived at the following conclusions, after years of study and residence in India:
1. Leprosy is an endemic disease, malignant, constitutional, progressive; evidenced by tubercular degeneration of the tissues, and accompanied by anaesthesia, ulceration, and gangrene; terminates in death from exhaustion, pyaemia, or rupture of the arteries.
2. That it is due to a specific bacillus he considers an unsettled point.
3. That leprosy is contagious only by inoculation, the direct transmission of the virus into the blood of healthy persons. This assertion does not exclude the transmission of the disease by clothing, tools, etc., which have been used by lepers.
4. The disease is practically limited to people living upon a fish diet along the sea coast.
5. It is incurable. The best treatment is only palliative. His experience with iodide of potash, iodoform, mercury, and other so-called antisyphilitics having been as satisfactory as with chaulmoogra oil and other rarer and costlier drugs.
6. The average life of the leper, after the full development of the disease, is from ten to fifteen years. This does not include the prodromal stage. Some cases die sooner, and some live much longer.
7. The period of incubation is less than one year; the prodromal stage may last for five or more years. Leontiasis may develop in twelve months, and may be the only hint of the latent disease for years, until some exciting cause brings it out.
8. Hereditary leprosy does not usually develop until the age of puberty, unless there be some exciting cause. This exciting cause may be inflammatory skin disease, suppurating wound, or prolonged illness.
Etiology.-If we may judge from Holy Writ, the ancient Jewish lawgivers regarded the disease as contagious. Modern science declares that it is not. The discovery in recent times of a peculiar bacillus by Hansen gives a clue to the medium of contagion, and corroborates the results of careful clinical observation. While we cannot doubt the possibility of contagion, we must admit that within the temperate zones the direct transfer of the disease from one person to another has been very rarely observed. It is by no means unusual for a Caucasian to contract the disease when dwelling among the natives where it is endemic; but it is extremely rare for him, on returning to his native country, to convey the malady to those whom he associates. During the past several years there have been a large number of lepers who have passed months and sometimes years in the hospitals of New York, and yet not a single case of leprosy has developed in this city.
Fox says: “The causes of propagation are mainly these:
1. Intermarriage of the leprous or with the leprous.
2. Hereditary transmission.
3. Inoculation and cohabitation.
4. Vaccination (?).
As to intermarriage, little need be said. It sufficiently accounts for the occurrence of a large number of cases of leprosy in the offspring of lepers, and the continuous intermarriage of people of the same caste in India, enforced rigidly by custom and superstition, tends greatly to the spread of leprosy hereditarily.
Secondly.-As regards hereditary influence, this is most marked in children who are begotten by lepers far advanced in the disease.
Thirdly.-As to cohabitation and inoculation. Of course, these are not such potent causes as intermarriage and hereditary tendency in spreading leprosy, but still it is probable that they may account for a certain number of cases.
